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Topic: What comes after the ACA? (Read 473236 times)

Health care providers must be forced to publish pricing. After time the decision to go with one provider over the another will be the same as choosing to purchase your clothes at Walmart as opposed to Neiman Marcus.

I really don't think this is true. People really don't make decisions about their health in the same way that people make other decisions. If I found out that one doctor was charging 2x more per procedure, I would not just reflexively go for the cheapest available. I would factor in how many times the doctor has performed the procedure, what his success rate is, the equipment he is using etc.... For example, when I got Lasik surgery, I could have had it done for half the price, but I chose an experienced ophthalmologist to perform the procedure, and he had a policy of free touch ups if your prescription was worse than 20/40.

Also, and I think this was stated upthread, in emergency situations, you aren't equipped to make these kind of decisions.

My mother was diagnosed with colon cancer 8 years ago. It was a genetic type. No worries, she is fine. My siblings and I, if we had the gene (50% chance- none of us have it) have a ~100% chance of getting colon cancer. No matter how healthy we are before then. If we were on individual insurance we would be dropped instantly.

On a positive note, this is actually untrue. Congress passed the Genetic Information Nondiscrimination Act in 2008, so they can't drop you (or raise premiums) for carrying a genetic mutation. In the pre-ACA world, as long as you didn't have any coverage gaps, you would be fine.

Minor downside: you will spend months arguing with the insurance company about this. Ask me how I know.

Oh, I want to know.

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"When plunder becomes a way of life for a group of men living together in society, they create for themselves in the course of time a legal system that authorizes it and a moral code that glorifies it." ~ Frederic Bastiat

I don't think all the people in power in this country believe this statement.

I don't believe this statement. One of the fundamental ideas of a "basic human right" is that they are ancient, as in recognized as true (by some group, not everyone) for as long as humanity can record. Another fundamental idea of a "basic human right" is that other people don't have to do anything, but instead are morally bound not to prevent the human in question from doing something for themselves. For example, I have a basic human right to life, and no one has a right to take my life away from me; where a "right" to healthcare would require someone else provide that service to me.

So no, you don't have a right to healthcare.

Logged

"When plunder becomes a way of life for a group of men living together in society, they create for themselves in the course of time a legal system that authorizes it and a moral code that glorifies it." ~ Frederic Bastiat

I think the young are supposed to subsidize the old, just like the healthy are supposed to subsidize the sick. That's how insurance works. Everyone pays more than their actual costs, unless they have sudden large costs and then they pay less. That's the whole point of insurance.

I just started reading this so its probably already been addressed, but no, this isn't how insurance works. Insurance works by saying there is a homogeneous group of risks with a certain likely expense. We pool those risks and charge the average cost of that pool to everyone in the pool. That way, by having enough people in the group, the random variation of a large individual loss is washed out and the average cost is born by all. (Ignoring expense). So far this sounds like what you said. Here's where it gets different. The american academy of actuaries (and many state legislatures) state that a rate should provide for the costs of individual risk transfer.

If young people on average have 2 claims per year at 500 per claim (Meaning the pool of young people would on average need to pay $1000) and old people on average have 12 claims per year at 500 per claim ($6000), then the rate should work regardless of the individuals in the group. Each individual should pay based upon their individual expected risks. This concept is why it costs more to insure a ferrari than a focus.

The use of 5:1 or 3:1 gets at affordability, which is different than the true function of insurance, as it requires a group to subsidize another group.

I think the young are supposed to subsidize the old, just like the healthy are supposed to subsidize the sick. That's how insurance works. Everyone pays more than their actual costs, unless they have sudden large costs and then they pay less. That's the whole point of insurance.

I just started reading this so its probably already been addressed, but no, this isn't how insurance works. Insurance works by saying there is a homogeneous group of risks with a certain likely expense. We pool those risks and charge the average cost of that pool to everyone in the pool. That way, by having enough people in the group, the random variation of a large individual loss is washed out and the average cost is born by all. (Ignoring expense). So far this sounds like what you said. Here's where it gets different. The american academy of actuaries (and many state legislatures) state that a rate should provide for the costs of individual risk transfer.

If young people on average have 2 claims per year at 500 per claim (Meaning the pool of young people would on average need to pay $1000) and old people on average have 12 claims per year at 500 per claim ($6000), then the rate should work regardless of the individuals in the group. Each individual should pay based upon their individual expected risks. This concept is why it costs more to insure a ferrari than a focus.

The use of 5:1 or 3:1 gets at affordability, which is different than the true function of insurance, as it requires a group to subsidize another group.

Except we don't have that for employee health insurance nor life insurance at my employer.

I don't think all the people in power in this country believe this statement.

I don't believe this statement. One of the fundamental ideas of a "basic human right" is that they are ancient, as in recognized as true (by some group, not everyone) for as long as humanity can record. Another fundamental idea of a "basic human right" is that other people don't have to do anything, but instead are morally bound not to prevent the human in question from doing something for themselves. For example, I have a basic human right to life, and no one has a right to take my life away from me; where a "right" to healthcare would require someone else provide that service to me.

I think the young are supposed to subsidize the old, just like the healthy are supposed to subsidize the sick. That's how insurance works. Everyone pays more than their actual costs, unless they have sudden large costs and then they pay less. That's the whole point of insurance.

I just started reading this so its probably already been addressed, but no, this isn't how insurance works. Insurance works by saying there is a homogeneous group of risks with a certain likely expense. We pool those risks and charge the average cost of that pool to everyone in the pool. That way, by having enough people in the group, the random variation of a large individual loss is washed out and the average cost is born by all. (Ignoring expense). So far this sounds like what you said. Here's where it gets different. The american academy of actuaries (and many state legislatures) state that a rate should provide for the costs of individual risk transfer.

If young people on average have 2 claims per year at 500 per claim (Meaning the pool of young people would on average need to pay $1000) and old people on average have 12 claims per year at 500 per claim ($6000), then the rate should work regardless of the individuals in the group. Each individual should pay based upon their individual expected risks. This concept is why it costs more to insure a ferrari than a focus.

The use of 5:1 or 3:1 gets at affordability, which is different than the true function of insurance, as it requires a group to subsidize another group.

Except we don't have that for employee health insurance nor life insurance at my employer.

Key information is highlighted. In fact, as is common for most places of employment, your coworkers and yourself constitute "the group" in question, which is why it probably says "group health" or "group life" on your employer sponsored plans. This is an advantage of employer subsidized group plans, that the older employees benefit, and that they can't be fired because they are older. They actually can legally be charged more for being older, but that is not common, because the company benefits from retention of experienced employees, particularly those with children still at home. This also highlights a work-around for those of us that manage to retire early, and wish to still get cheap-ish health care. Get a part-time job at a business that typically employees more young adults, but still allows buy-ins for the part-timers. This is hard, but not terribly uncommon. I know that, once upon a time, Wal-Mart permitted part-timers with at least a year of time at the company to 'buy-in' to the health plan, as well as many national chain grocers. Since a great many of these jobs are barely above minimum wage anyway, they are often transitional jobs for teens & young adults, which suppresses the average liability and (in theory) should keep the average cost of the group plan lower. Not cheap, likely, since the company doesn't typically subsidize the part-timers much or any; but cheaper (for the mid to high risk, certainly) than a private plan on the open market.

Logged

"When plunder becomes a way of life for a group of men living together in society, they create for themselves in the course of time a legal system that authorizes it and a moral code that glorifies it." ~ Frederic Bastiat

I don't think all the people in power in this country believe this statement.

I don't believe this statement. One of the fundamental ideas of a "basic human right" is that they are ancient, as in recognized as true (by some group, not everyone) for as long as humanity can record. Another fundamental idea of a "basic human right" is that other people don't have to do anything, but instead are morally bound not to prevent the human in question from doing something for themselves. For example, I have a basic human right to life, and no one has a right to take my life away from me; where a "right" to healthcare would require someone else provide that service to me.

So no, you don't have a right to healthcare.

Scrooge, is that you?

I'm approaching that age group, so I'll answer to that name if it means that much to you.

Logged

"When plunder becomes a way of life for a group of men living together in society, they create for themselves in the course of time a legal system that authorizes it and a moral code that glorifies it." ~ Frederic Bastiat

Several people in this thread have mentioned that there is no way to make health insurance affordable to all Americans as long as healthcare costs are so high. I think this is wrong. There IS a way to give everyone affordable insurance without controlling costs at all. Insurers and hospitals/doctors can continue to get rich, and everyone can have access to affordable care. I think I've cracked the nut.

What secret sauce have I invented? The key is in the definition of "affordable". Just pay 100% of everyone's private health insurance premium with tax dollars.

Think about this. Taxes are already designed to be "affordable" to everyone. They are progressive (for income tax, so the rich pay more) and they are also a flat tax (for OASDI, which everyone pays the same percentage regardless of income). No one ever goes broke because of taxes. If you have no income, you pay no taxes. If you have lots of money, you pay lots of taxes but you still have lots of money. In both cases, taxes are "affordable" to you. Why can't health insurance work the same way?

The 100% covered premiums would have to be for basic services, of course, not cadillac plans. Maybe make them similar to current subsidized silver plans, say 100% coverage for routine preventative care, $25 copays for other stuff, and $1k per person deductibles so everyone pays for their first basic care out of pocket. People who want more than basic coverage could still buy it, if they can afford it. Exclude cosmetic procedures. Revoke HSAs. Your doctor would bill your insurance company just like it does now, and your insurance company would bill Uncle Sam instead of you. The private insurance industry would become just like the post office, a quasi-government for-profit corporation subject to federal oversight and regulation, that provides a uniformly available service for the common good and receives periodic bailouts when necessary and makes good money the rest of the time.

If you have employer-sponsored insurance, nothing would need to change. The money your employer currently pays towards your insurance would get paid to Uncle Sam as taxes. If you run a small business, you don't need to worry about providing healthcare to your employees if you don't want to. If you are unemployed or retired, your health insurance is now covered just like your unemployment insurance and disability insurance are already covered under current law.

So this solutions obviously isn't a 100% free ride for everyone. If Uncle Sam is paying all of this extra money for health insurance premiums, where is the money coming from? Your taxes, of course. You can either raise tax rates (either the progressive income tax brackets or the flat OASDI taxes or both, or other taxes) or you can cut spending. Doesn't really matter. The key is that taxes are always "affordable" by design, so we're piggy-backing on that system. Theoretically, your savings from not buying your current insurance should cover your costs from higher taxes.

In either case, the government basically becomes the only end-consumer of health insurance. They can negotiate rates with the private insurance companies, who can negotiate with providers, to bring long term costs under control. Medicare already pays a fixed amount for MRIs, and that amount should be the MRI price for EVERYONE, not just old people. Similar arguments apply for any other billable procedure. They also get to ration care, for example by denying cosmetic surgery for old ladies who are vain or providing palliative care instead of invasive surgery for 90 year-olds with aggressive cancer. If you are a billionaire 90 year-old with brain cancer, you can buy additional insurance or pay out of pocket, but even if you don't your basic care is covered just like it is for everyone else.

Everyone gets affordable health care! You are covered, your rates are affordable to you, and no one will ever go medically bankrupt again!

There is no individual mandate! You're not forced to buy anything. The government is buying it for you, just like it buys national defense for you, because we all need it.

There is no denial for pre-existing conditions! Everyone gets (reasonable) care regardless of health history. And you can always buy more if you can afford it.

Emergency care is still available to everyone, but won't be the only care available to poor people! There is no need to repeal EMTALA.

It's not single payer! The insurance industry isn't nationalized, and they continue to exist as profitable private corporations.

I'm open to suggestions and criticisms of this plan. There are clearly a thousand details to complicate the implementation, but the overarching idea of just raising taxes to pay for universally available private insurance seems like the only way to give everyone what they want.

At first glance it seems pretty interesting. But how would this not become defacto single-payer (which of course I do support)? Why would the government want to pay premiums to dozens of different companies? Would individuals still be picking their preferred provider? Does this become complicated when one provider provides better service for less costs than another (not always easy to measure of course)? Are we OK with the inevitable waste/corruption that could arise?

This also wouldn't address the underlying issue of the ridiculous pricing system in place for individual medical procedures. I'm struggling to see how it could possibly be more effective or remotely as efficient as a single-payer system. I mean, the insurance industry does get to continue existing, I suppose...

ETA - I guess the government could mandate that all providers provide the same basic plan for the same price, and it would be the premium plans that would be subject to the market? Hmm.

I'm struggling to see how it could possibly be more effective or remotely as efficient as a single-payer system.

It's not. Single payer is a financially more logical idea, but it it politically impossible right now. This plan is like single payer, but with government subsidies to private companies, which is just like what we have now but on a larger scale.

Private insurers would be the middle man, just like defense contractors. They make a profit by doing the government's job for them, even if the government could do it more efficiently itself.

But it would accomplish many of the same goals as single payer, without the primary drawback (destroying the private insurance industry). I think insurers would have to be regulated, to ensure they provided this service uniformly to all Americans at a reasonable level of profit (also like the post office). And to ensure they remained solvent, because a bankrupt insurance provider is no good to anyone.

in response to "how could this be more effective as a single payer system" I'd offer this:It might be possible to have both: A single-payer health care system that provides basic services similar to what Sol describes above, and the "additional" health care provided by private insurance companies with profit limitations that provides more extensive coverage.

Heck, Republicans could repeal the ACA and replace it with 100% premiums paid guaranteed issue basic coverage required by law to be available from every insurance company, and claim victory without even bothering to raise taxes. They're already talking about a trillion dollars of deficit spending on infrastructure, why not make it a half trillion and spend the other half trillion on sticking it to Obama by offering a viable replacement plan that makes Obamacare look like shit?

No worries about 5:1 ratios, no more subsidy cliffs, no more mandate, it's everything they ever wanted and it might actually be good for both the American people AND their big money private business donors. They might even get some democrats to vote for it.

And it seems so easy to do. Congress just spells out the provisions of a basic insurance plan, and requires every insurer in every US market to sell it to everyone for the same specified price or pay ~100% tax rates (to subsidize the ones that do comply). Each insurer that complies would get to claim the premium payments for each new customer from the government directly, and would get a bailout guarantee if the policies don't turn out to be profitable.

I don't think all the people in power in this country believe this statement.

I don't believe this statement. One of the fundamental ideas of a "basic human right" is that they are ancient, as in recognized as true (by some group, not everyone) for as long as humanity can record. Another fundamental idea of a "basic human right" is that other people don't have to do anything, but instead are morally bound not to prevent the human in question from doing something for themselves. For example, I have a basic human right to life, and no one has a right to take my life away from me; where a "right" to healthcare would require someone else provide that service to me.

So no, you don't have a right to healthcare.

So, you'd eliminate pretty much all the rights enumerated in the constitution?

Heck, Republicans could repeal the ACA and replace it with 100% premiums paid guaranteed issue basic coverage required by law to be available from every insurance company, and claim victory without even bothering to raise taxes. They're already talking about a trillion dollars of deficit spending on infrastructure, why not make it a half trillion and spend the other half trillion on sticking it to Obama by offering a viable replacement plan that makes Obamacare look like shit?

No worries about 5:1 ratios, no more subsidy cliffs, no more mandate, it's everything they ever wanted and it might actually be good for both the American people AND their big money private business donors. They might even get some democrats to vote for it.

And it seems so easy to do. Congress just spells out the provisions of a basic insurance plan, and requires every insurer in every US market to sell it to everyone for the same specified price or pay ~100% tax rates (to subsidize the ones that do comply). Each insurer that complies would get to claim the premium payments for each new customer from the government directly, and would get a bailout guarantee if the policies don't turn out to be profitable.

Everyone wins?

Agreed - and let's go a step further and give every person over 18 poverty level payment too. So everyone gets say - $1000 a month. And then we close housing, welfare, food stamps, etc. You get $200 per month for each kid up to 2. Want more kids - make it work on what you get. Once you are able to take social security - you choose based on what pays more - social security or your poverty payment. It turns out that eliminating all of the bureaucracy of welfare, housing, food stamps, etc. - this will save money. Want to live a better life and have more - get a job.

Agreed - and let's go a step further and give every person over 18 poverty level payment too.

I don't think the country is ready for universal basic income yet, but your premise is probably relevant in the health insurance world. They could certainly flat out repeal Medicaid and Medicare to help pay for 100% federal coverage of premiums for guaranteed-issue basic health insurance. Who needs those programs when everyone already has Trumpcare?

Heck, Republicans could repeal the ACA and replace it with 100% premiums paid guaranteed issue basic coverage required by law to be available from every insurance company, and claim victory without even bothering to raise taxes. They're already talking about a trillion dollars of deficit spending on infrastructure, why not make it a half trillion and spend the other half trillion on sticking it to Obama by offering a viable replacement plan that makes Obamacare look like shit?

No worries about 5:1 ratios, no more subsidy cliffs, no more mandate, it's everything they ever wanted and it might actually be good for both the American people AND their big money private business donors. They might even get some democrats to vote for it.

And it seems so easy to do. Congress just spells out the provisions of a basic insurance plan, and requires every insurer in every US market to sell it to everyone for the same specified price or pay ~100% tax rates (to subsidize the ones that do comply). Each insurer that complies would get to claim the premium payments for each new customer from the government directly, and would get a bailout guarantee if the policies don't turn out to be profitable.

Everyone wins?

sol I think this is the first logical plan I've read that preserves or expands the intent of ACA while still giving everyone something they want. Kudos! Now how do we communicate it to the people that write the laws?

I'm open to suggestions and criticisms of this plan. There are clearly a thousand details to complicate the implementation, but the overarching idea of just raising taxes to pay for universally available private insurance seems like the only way to give everyone what they want.

First objection... Who decides what defines a "Basic" level plan? I consider the current bronze to be way beyond what I practically need. Even if I were to agree that the starting plan really was "basic", will I actually have an effective opt-out option? Can I freely agree to a less comprehensive plan than the "basic" standard without an economic penalty (compared to my basic plan peer with his premiums paid by taxes)? Or am I going to have to forego the basic plan's subsidies while still paying for my peer's plan through my own taxes?

Second objection... If you are advocating abolishing HSAs, you can't also say that you are allowing plans that work for everyone. I love my HSA, in part, because I allows me to actually become a risk pool of one, over my remaining lifetime instead of per calendar year.

Logged

"When plunder becomes a way of life for a group of men living together in society, they create for themselves in the course of time a legal system that authorizes it and a moral code that glorifies it." ~ Frederic Bastiat

I don't think all the people in power in this country believe this statement.

I don't believe this statement. One of the fundamental ideas of a "basic human right" is that they are ancient, as in recognized as true (by some group, not everyone) for as long as humanity can record. Another fundamental idea of a "basic human right" is that other people don't have to do anything, but instead are morally bound not to prevent the human in question from doing something for themselves. For example, I have a basic human right to life, and no one has a right to take my life away from me; where a "right" to healthcare would require someone else provide that service to me.

So no, you don't have a right to healthcare.

So, you'd eliminate pretty much all the rights enumerated in the constitution?

If you think that the Bill of Rights compel other citizens to do something for me, you don't understand what they are.

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"When plunder becomes a way of life for a group of men living together in society, they create for themselves in the course of time a legal system that authorizes it and a moral code that glorifies it." ~ Frederic Bastiat

Heck, Republicans could repeal the ACA and replace it with 100% premiums paid guaranteed issue basic coverage required by law to be available from every insurance company, and claim victory without even bothering to raise taxes. They're already talking about a trillion dollars of deficit spending on infrastructure, why not make it a half trillion and spend the other half trillion on sticking it to Obama by offering a viable replacement plan that makes Obamacare look like shit?

No worries about 5:1 ratios, no more subsidy cliffs, no more mandate, it's everything they ever wanted and it might actually be good for both the American people AND their big money private business donors. They might even get some democrats to vote for it.

And it seems so easy to do. Congress just spells out the provisions of a basic insurance plan, and requires every insurer in every US market to sell it to everyone for the same specified price or pay ~100% tax rates (to subsidize the ones that do comply). Each insurer that complies would get to claim the premium payments for each new customer from the government directly, and would get a bailout guarantee if the policies don't turn out to be profitable.

I'm open to suggestions and criticisms of this plan. There are clearly a thousand details to complicate the implementation, but the overarching idea of just raising taxes to pay for universally available private insurance seems like the only way to give everyone what they want.

First objection... Who decides what defines a "Basic" level plan? I consider the current bronze to be way beyond what I practically need. Even if I were to agree that the starting plan really was "basic", will I actually have an effective opt-out option? Can I freely agree to a less comprehensive plan than the "basic" standard without an economic penalty (compared to my basic plan peer with his premiums paid by taxes)? Or am I going to have to forego the basic plan's subsidies while still paying for my peer's plan through my own taxes?

Second objection... If you are advocating abolishing HSAs, you can't also say that you are allowing plans that work for everyone. I love my HSA, in part, because I allows me to actually become a risk pool of one, over my remaining lifetime instead of per calendar year.

Everybody gets coverage at no cost to them. There is no tax penalty if you don't sign up and use it. Use it or not. And there would have to be HSAs to cover deductibles and out of pocket maximums.

I'm open to suggestions and criticisms of this plan. There are clearly a thousand details to complicate the implementation, but the overarching idea of just raising taxes to pay for universally available private insurance seems like the only way to give everyone what they want.

First objection... Who decides what defines a "Basic" level plan? I consider the current bronze to be way beyond what I practically need. Even if I were to agree that the starting plan really was "basic", will I actually have an effective opt-out option? Can I freely agree to a less comprehensive plan than the "basic" standard without an economic penalty (compared to my basic plan peer with his premiums paid by taxes)? Or am I going to have to forego the basic plan's subsidies while still paying for my peer's plan through my own taxes?

Second objection... If you are advocating abolishing HSAs, you can't also say that you are allowing plans that work for everyone. I love my HSA, in part, because I allows me to actually become a risk pool of one, over my remaining lifetime instead of per calendar year.

Everybody gets coverage at no cost to them. There is no tax penalty if you don't sign up and use it. Use it or not. And there would have to be HSAs to cover deductibles and out of pocket maximums.

So, yes, I would lose the advantage of the tax subsidy if I were to chose a different plan, then? At least with my local school district taxes, I benefit that there aren't a bunch of ignorant pre-teens running around my neighborhood like stray dogs in the middle of the daytime. With this "basic" plan idea, I'd not even get a token benefit for my taxes.

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"When plunder becomes a way of life for a group of men living together in society, they create for themselves in the course of time a legal system that authorizes it and a moral code that glorifies it." ~ Frederic Bastiat

Great summary Sol, and great discussion. In my opinion health care costs are the biggest concern for early retirees. There is nothing that can destroy a budget faster than a serious medical problem. The ACA was a gift to the early retiree, too good to be true in many ways. I think the biggest lesson here is that changes in health care, tax or entitlement policy can have a massively negative impact.

Working in medicine I can tell you that using the 'free market' to control your costs will probably not work, because you are not the customer. The insurance company is the customer and you are just along for the ride. Insurance companies will fight to control their costs, but they don't really care what you pay. Navigating the 'in/out of network' maze is infuriating, and many times there is a shortage of specialists in your geographic area anyways so it's a moot point. Sure, you can negotiate on non-emergent services if you are self-pay and save a bit, but the big costs come from medical emergencies where you don't have any negotiating power. A trip to the ICU for a few days can wipe out a decade worth of HSA contributions. Cancer or some other chronic illness can max your deductible every year. It's a real problem.

What we really need is to find way to decrease costs of medical care in the US. I'm not sure how to do this. The ACA was designed to get everyone insured, but it didn't really address the cost issue. Until this problem is solved there is no math that will make medical care affordable on a population level. We spend over $10,000 per person each year. There is no magical way to pay for this without people paying huge premiums and out of pocket costs. The ACA was designed to smooth this cost out a bit, mainly by forcing healthy and rich people to pay more. http://www.pbs.org/newshour/rundown/new-peak-us-health-care-spending-10345-per-person/

Insane. There is no solution to this problem with any of the proposals. Maybe a single payer could accomplish this, but as others have stated this is politically impossible. Whatever comes next will be great for healthy people, and not so great for sick people. You will likely be OK if you are either really rich or really poor (assuming Medicaid isn't destroyed). Don't get sick in the United States.

^ One of the best post I have read so far on the topic.

As long as we have insurance taking a cut on every medical expense expecting large profits,As long as we have government regulations forcing extra personel to comply with them yet provide no patient benefitAs long as the FDA has difficult and expensive hurdles to create a new productsAs long as we have no price transparency in medicineAs long as people expect to pay nothing and get everythingAs long as people continue dangerous lifestyle choices and get bailed out by our healthcare industryAs long as we continue providing expensive healthcare to the almost brain dead or those with no quality of lifeNo health care plan will fix the problem

Second objection... If you are advocating abolishing HSAs, you can't also say that you are allowing plans that work for everyone. I love my HSA, in part, because I allows me to actually become a risk pool of one, over my remaining lifetime instead of per calendar year.

I don't remember reading about the right to an HSA in the "Bill of Rights". ;)

Second objection... If you are advocating abolishing HSAs, you can't also say that you are allowing plans that work for everyone. I love my HSA, in part, because I allows me to actually become a risk pool of one, over my remaining lifetime instead of per calendar year.

I don't remember reading about the right to an HSA in the "Bill of Rights". ;)

Well, I don't remember reading about the right to social security payments at 65 either, so be careful what you might advocate abolishing!

Logged

"When plunder becomes a way of life for a group of men living together in society, they create for themselves in the course of time a legal system that authorizes it and a moral code that glorifies it." ~ Frederic Bastiat

I'm open to suggestions and criticisms of this plan. There are clearly a thousand details to complicate the implementation, but the overarching idea of just raising taxes to pay for universally available private insurance seems like the only way to give everyone what they want.

First objection... Who decides what defines a "Basic" level plan? I consider the current bronze to be way beyond what I practically need. Even if I were to agree that the starting plan really was "basic", will I actually have an effective opt-out option? Can I freely agree to a less comprehensive plan than the "basic" standard without an economic penalty (compared to my basic plan peer with his premiums paid by taxes)? Or am I going to have to forego the basic plan's subsidies while still paying for my peer's plan through my own taxes?

Second objection... If you are advocating abolishing HSAs, you can't also say that you are allowing plans that work for everyone. I love my HSA, in part, because I allows me to actually become a risk pool of one, over my remaining lifetime instead of per calendar year.

Everybody gets coverage at no cost to them. There is no tax penalty if you don't sign up and use it. Use it or not. And there would have to be HSAs to cover deductibles and out of pocket maximums.

So, yes, I would lose the advantage of the tax subsidy if I were to chose a different plan, then? At least with my local school district taxes, I benefit that there aren't a bunch of ignorant pre-teens running around my neighborhood like stray dogs in the middle of the daytime. With this "basic" plan idea, I'd not even get a token benefit for my taxes.

EVERYBODY is covered by the same bronze plan at no cost to them. The government pays the premium if you want that coverage. If you don't want the coverage - don't use it. There is no tax subsidy. It is like the highways - use them if you want - or not. You pay the same either way. In this manner - emergency rooms would have limited exposure (the deductible). Want better insurance - buy it. Want less insurance - use less. I don't understand what you don't understand. There is no tax "subsidy" to lose. It is, of course, highly unlikely that anybody would offer a plan with less coverage because you are the only person who would buy it.

I don't understand what you don't understand. There is no tax "subsidy" to lose. It is, of course, highly unlikely that anybody would offer a plan with less coverage because you are the only person who would buy it.

Of course there is, just because you don't see it, doesn't mean it's not there.

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"When plunder becomes a way of life for a group of men living together in society, they create for themselves in the course of time a legal system that authorizes it and a moral code that glorifies it." ~ Frederic Bastiat

I don't think all the people in power in this country believe this statement.

I don't believe this statement. One of the fundamental ideas of a "basic human right" is that they are ancient, as in recognized as true (by some group, not everyone) for as long as humanity can record. Another fundamental idea of a "basic human right" is that other people don't have to do anything, but instead are morally bound not to prevent the human in question from doing something for themselves. For example, I have a basic human right to life, and no one has a right to take my life away from me; where a "right" to healthcare would require someone else provide that service to me.

So no, you don't have a right to healthcare.

So, you'd eliminate pretty much all the rights enumerated in the constitution?

If you think that the Bill of Rights compel other citizens to do something for me, you don't understand what they are.

Heck, Republicans could repeal the ACA and replace it with 100% premiums paid guaranteed issue basic coverage required by law to be available from every insurance company, and claim victory without even bothering to raise taxes. They're already talking about a trillion dollars of deficit spending on infrastructure, why not make it a half trillion and spend the other half trillion on sticking it to Obama by offering a viable replacement plan that makes Obamacare look like shit?

No worries about 5:1 ratios, no more subsidy cliffs, no more mandate, it's everything they ever wanted and it might actually be good for both the American people AND their big money private business donors. They might even get some democrats to vote for it.

And it seems so easy to do. Congress just spells out the provisions of a basic insurance plan, and requires every insurer in every US market to sell it to everyone for the same specified price or pay ~100% tax rates (to subsidize the ones that do comply). Each insurer that complies would get to claim the premium payments for each new customer from the government directly, and would get a bailout guarantee if the policies don't turn out to be profitable.

Everyone wins?

Sounds good to me! Of course it'll never happen (quibbles over what qualifies as basic insurance for women's health immediately comes to mind).

Second objection... If you are advocating abolishing HSAs, you can't also say that you are allowing plans that work for everyone. I love my HSA, in part, because I allows me to actually become a risk pool of one, over my remaining lifetime instead of per calendar year.

I don't remember reading about the right to an HSA in the "Bill of Rights". ;)

Well, I don't remember reading about the right to social security payments at 65 either, so be careful what you might advocate abolishing!

In general I'm against all itemized deductions for health care. There should be no deductions for premiums, costs, HSAs etc. Such deductions almost always increase costs. I have said this before, I'm pretty much against most deductions.

Second objection... If you are advocating abolishing HSAs, you can't also say that you are allowing plans that work for everyone. I love my HSA, in part, because I allows me to actually become a risk pool of one, over my remaining lifetime instead of per calendar year.

I don't remember reading about the right to an HSA in the "Bill of Rights". ;)

Well, I don't remember reading about the right to social security payments at 65 either, so be careful what you might advocate abolishing!

In general I'm against all itemized deductions for health care. There should be no deductions for premiums, costs, HSAs etc. Such deductions almost always increase costs. I have said this before, I'm pretty much against most deductions.

I understand, and respect, your position. I'm just saying that I don't agree, and in order to get your way, odds are high you are going to lose something you like as well.

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"When plunder becomes a way of life for a group of men living together in society, they create for themselves in the course of time a legal system that authorizes it and a moral code that glorifies it." ~ Frederic Bastiat

Second objection... If you are advocating abolishing HSAs, you can't also say that you are allowing plans that work for everyone. I love my HSA, in part, because I allows me to actually become a risk pool of one, over my remaining lifetime instead of per calendar year.

I don't remember reading about the right to an HSA in the "Bill of Rights". ;)

Well, I don't remember reading about the right to social security payments at 65 either, so be careful what you might advocate abolishing!

In general I'm against all itemized deductions for health care. There should be no deductions for premiums, costs, HSAs etc. Such deductions almost always increase costs. I have said this before, I'm pretty much against most deductions.

I understand, and respect, your position. I'm just saying that I don't agree, and in order to get your way, odds are high you are going to lose something you like as well.

Yes, there are things that I hugely benefit from like the 401k/IRA deductions, the health insurance premium deductions, the mortgage interest deductions, the reduced tax rates on capital gains and dividends. But, I'd rather have a larger standard deduction that benefits everyone and a plan that will significantly simplify the tax code. It is theoretical at this point, but I'm willing to take some of that pain. For the good of our country and the vast majority of its citizens, it is required to have a dialogue that results in coming up with a plan and scheme that benefits this majority.

The same people who determined what defines a "basic" level of disability insurance and unemployment were, and then provided them to you. You currently have those, paid for with your tax dollars. Do you feel like they are excessive? Do you want to opt out of them? Congress disagrees with you. Do you feel like you are unfairly being asked to pay for your peers plans? That's kind of the point of insurance.

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Second objection... If you are advocating abolishing HSAs, you can't also say that you are allowing plans that work for everyone.

I love my HSA too, but I also recognize it is a tax break for the rich and I personally think we can safely repeal some tax breaks in order to pay for providing affordable insurance to everyone. I'd rather have affordable health insurance than a worthless tax deduction. I can't afford $20k/year for medical no matter what kind of tax deduction you give me, once I am retired and living on $40k/year and not paying any income taxes.

(quibbles over what qualifies as basic insurance for women's health immediately comes to mind).

I don't think that one is really so hard, personally, but I'm not the one who would have to vote for it in Congress. What do medicaid and medicare currently pay for? Just pay for that, and let people who want more than that either pay for it themselves, or buy additional insurance.

That depends on your income, I suppose. What percentage of your income does your healthcare currently cost?

I suppose the answer could be "zero" if you have no income and thus pay no taxes. I think even homeless people deserve an annual checkup. Maybe it will keep them out of emergency rooms.

For everyone else I suppose the answer would be "as high as your effective tax rate" which could be just about anything. But it would be mixed in with everything else the government buys with your tax dollars. No one asks "what percentage of my income does national defense cost" because our national defense is paid for out of our collective taxes, and there's no way to track where your specific tax dollars go after you pay taxes. At best, we can say something like "16% of federal tax revenue is spent on national defense" and then you can multiply your individual tax burden by 16%.

For everyone else I suppose the answer would be "as high as your effective tax rate" which could be just about anything. But it would be mixed in with everything else the government buys with your tax dollars. No one asks "what percentage of my income does national defense cost" because our national defense is paid for out of our collective taxes, and there's no way to track where your specific tax dollars go after you pay taxes. At best, we can say something like "16% of federal tax revenue is spent on national defense" and then you can multiply your individual tax burden by 16%.

This is a key point. Of course the "taxes are theft" folks will still disagree on principle, but their principles are based on an ignorance of historical context, understanding of how the economy works, and/or empathy for others, so I'm not sure their opinions are particularly relevant.

For everyone else I suppose the answer would be "as high as your effective tax rate" which could be just about anything. But it would be mixed in with everything else the government buys with your tax dollars. No one asks "what percentage of my income does national defense cost" because our national defense is paid for out of our collective taxes, and there's no way to track where your specific tax dollars go after you pay taxes. At best, we can say something like "16% of federal tax revenue is spent on national defense" and then you can multiply your individual tax burden by 16%.

This is a key point. Of course the "taxes are theft" folks will still disagree on principle, but their principles are based on an ignorance of historical context, understanding of how the economy works, and/or empathy for others, so I'm not sure their opinions are particularly relevant.

Do you not proof read your posts first? Or do you just not care how offensive you sound to those whose opinions you do not share?

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"When plunder becomes a way of life for a group of men living together in society, they create for themselves in the course of time a legal system that authorizes it and a moral code that glorifies it." ~ Frederic Bastiat

The same people who determined what defines a "basic" level of disability insurance and unemployment were, and then provided them to you. You currently have those, paid for with your tax dollars. Do you feel like they are excessive? Do you want to opt out of them? Congress disagrees with you. Do you feel like you are unfairly being asked to pay for your peers plans? That's kind of the point of insurance.

Once again, no it is not. True insurance is not a cost transfer system. It is only a hedge against unlikely, but expensive, life events. Annual checkups don't count, they are both predictable and not particularly expensive anyway. And I already pay for those through my taxes for the homeless, that's why free health clinics exist. If your "basic" health plan only covered the truly unlikely events, that cannot reasonably be tied to lifestyle; such as most forms of cancer, but not lung cancer for the chronic smoker or skin cancer for the sun bathing addicts, we might have something to talk about. But to anything that could be provided by a free clinic today, no. I might commit to taxpayer funded birth control, but only as a condition of providing free health care, and of the type that does not depend upon the ongoing responsibility of the person receiving benefits.

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"When plunder becomes a way of life for a group of men living together in society, they create for themselves in the course of time a legal system that authorizes it and a moral code that glorifies it." ~ Frederic Bastiat

Second objection... If you are advocating abolishing HSAs, you can't also say that you are allowing plans that work for everyone. I love my HSA, in part, because I allows me to actually become a risk pool of one, over my remaining lifetime instead of per calendar year.

I don't remember reading about the right to an HSA in the "Bill of Rights". ;)

Well, I don't remember reading about the right to social security payments at 65 either, so be careful what you might advocate abolishing!

In general I'm against all itemized deductions for health care. There should be no deductions for premiums, costs, HSAs etc. Such deductions almost always increase costs. I have said this before, I'm pretty much against most deductions.

I understand, and respect, your position. I'm just saying that I don't agree, and in order to get your way, odds are high you are going to lose something you like as well.

Yes, there are things that I hugely benefit from like the 401k/IRA deductions, the health insurance premium deductions, the mortgage interest deductions, the reduced tax rates on capital gains and dividends. But, I'd rather have a larger standard deduction that benefits everyone and a plan that will significantly simplify the tax code. It is theoretical at this point, but I'm willing to take some of that pain. For the good of our country and the vast majority of its citizens, it is required to have a dialogue that results in coming up with a plan and scheme that benefits this majority.

Well, best of luck to you. As for myself, I'm just going to try and enjoy the decline.

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"When plunder becomes a way of life for a group of men living together in society, they create for themselves in the course of time a legal system that authorizes it and a moral code that glorifies it." ~ Frederic Bastiat

For everyone else I suppose the answer would be "as high as your effective tax rate" which could be just about anything. But it would be mixed in with everything else the government buys with your tax dollars. No one asks "what percentage of my income does national defense cost" because our national defense is paid for out of our collective taxes, and there's no way to track where your specific tax dollars go after you pay taxes. At best, we can say something like "16% of federal tax revenue is spent on national defense" and then you can multiply your individual tax burden by 16%.

This is a key point. Of course the "taxes are theft" folks will still disagree on principle, but their principles are based on an ignorance of historical context, understanding of how the economy works, and/or empathy for others, so I'm not sure their opinions are particularly relevant.

Do you not proof read your posts first? Or do you just not care how offensive you sound to those whose opinions you do not share?

Well, this is a fair objection, in some respects. I don't pretend to be tactful. The thing is that this is far from the first forum in which i have fought this particular fight. And it gets old. I'm sure those favoring your worldview feel the same. So to repeat myself yet again, the short version here is that the opportunity (which is unprecedented in human history) to be collectively able to have this conversation, is based in the history of the society in which we reside, which was built upon taxation of the resident populous. That we are all able to consider the possibility of FIRE is very much thanks to the fruits of those taxes. In this increasingly automated world, that it might still be possible to continue to grow the economy for the benefit of all is a direct result of what taxation has wrought. I do not claim that taxes are universally well implemented (quite the opposite), but it is absurd to claim they are theft when the reality is that they have enabled more wealth than would have otherwise been possible. I have little patience for people who deal in absolutes.

So we're arguing single payer is political unfeasible, but abolishing medicare is a cornerstone of this plan?

Though I can see something like this gaining support: "Just let the government pay for everyone's health insurance out of taxes." Never mind that it would by necessity be cheaper to pay healthcare providers directly.

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Give me one fine day of plain sailing weather and I can mess up anything.

That depends on your income, I suppose. What percentage of your income does your healthcare currently cost?

I suppose the answer could be "zero" if you have no income and thus pay no taxes. I think even homeless people deserve an annual checkup. Maybe it will keep them out of emergency rooms.

For everyone else I suppose the answer would be "as high as your effective tax rate" which could be just about anything. But it would be mixed in with everything else the government buys with your tax dollars. No one asks "what percentage of my income does national defense cost" because our national defense is paid for out of our collective taxes, and there's no way to track where your specific tax dollars go after you pay taxes. At best, we can say something like "16% of federal tax revenue is spent on national defense" and then you can multiply your individual tax burden by 16%.

Back of the envelope calculation is it would roughly double taxes. Total US spending on healthcare in 2015 was $3.2 trillion, of which the federal government already paid about $1 trillion, leaving $2.2 trillion. Total taxes collected from individuals was about $2.5 trillion.Or, roughly a 14% tax on all wages, without any deductions.

For everyone else I suppose the answer would be "as high as your effective tax rate" which could be just about anything. But it would be mixed in with everything else the government buys with your tax dollars. No one asks "what percentage of my income does national defense cost" because our national defense is paid for out of our collective taxes, and there's no way to track where your specific tax dollars go after you pay taxes. At best, we can say something like "16% of federal tax revenue is spent on national defense" and then you can multiply your individual tax burden by 16%.

This is a key point. Of course the "taxes are theft" folks will still disagree on principle, but their principles are based on an ignorance of historical context, understanding of how the economy works, and/or empathy for others, so I'm not sure their opinions are particularly relevant.

Do you not proof read your posts first? Or do you just not care how offensive you sound to those whose opinions you do not share?

Well, this is a fair objection, in some respects. I don't pretend to be tactful. The thing is that this is far from the first forum in which i have fought this particular fight. And it gets old. I'm sure those favoring your worldview feel the same. So to repeat myself yet again, the short version here is that the opportunity (which is unprecedented in human history) to be collectively able to have this conversation, is based in the history of the society in which we reside, which was built upon taxation of the resident populous. That we are all able to consider the possibility of FIRE is very much thanks to the fruits of those taxes. In this increasingly automated world, that it might still be possible to continue to grow the economy for the benefit of all is a direct result of what taxation has wrought. I do not claim that taxes are universally well implemented (quite the opposite), but it is absurd to claim they are theft when the reality is that they have enabled more wealth than would have otherwise been possible. I have little patience for people who deal in absolutes.

It's easy to talk about how stupid and dependent everyone else is when you first disabuse yourself of the notion that you live in a society.

"I got mine, Jack."

Seriously, Quidnon, government policy is pretty much how we make decisions about things that affect all of us. Participate or don't, but acting like you're somehow not in a society is just obnoxious. If everyone else was a unicorn of personal responsibility like you, then we would live in a free market utopia where nothing bad ever happens.

I think that's going to be my new band name, Unicorn of Personal Responsibility.

For everyone else I suppose the answer would be "as high as your effective tax rate" which could be just about anything. But it would be mixed in with everything else the government buys with your tax dollars. No one asks "what percentage of my income does national defense cost" because our national defense is paid for out of our collective taxes, and there's no way to track where your specific tax dollars go after you pay taxes. At best, we can say something like "16% of federal tax revenue is spent on national defense" and then you can multiply your individual tax burden by 16%.

This is a key point. Of course the "taxes are theft" folks will still disagree on principle, but their principles are based on an ignorance of historical context, understanding of how the economy works, and/or empathy for others, so I'm not sure their opinions are particularly relevant.

Do you not proof read your posts first? Or do you just not care how offensive you sound to those whose opinions you do not share?

Quidnon, your posts about health care in this and other threads are full of meaningless hyperbole. Everything you disagree with is PROPAGANDA and health care a serious incursion on your FREEDOM. People here are (rightly, I think) interpreting your comments as nothing more than ridiculous histrionics and are poking fun at you because of it. From what I can tell, your main objection to the ACA is that it is more expensive for you personally than plans you had in the old private insurance market. That's actually a legitimate beef! You're probably going to get more traction with the argument "the ACA is simply too expensive for individuals like me" than trying to connect it to some grave threat to your personal autonomy and the stability of the republic.